'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Readers' letters make more sense than NICE guidance

There were two star letters in the March 15 issue that I hope will be widely read and provoke colleagues to reflect on two important, if not vital, factors affecting modern general practice.

The first was from Dr Graham Barrowcliffe about HRT.

He reminds us of two findings of studies completed some time ago that showed not only was the all-cause death rate in patients developing breast cancer while taking HRT lower than for those not taking it but the prognosis for their cancer was better.

This has been known to many of us for a long time and is an important mediator of the increased incidence of breast cancer in users of HRT for over five-seven years. It has not been much discussed in the press.

The second point he made was that doctors should inform and advise patients but it remains the patient's right to decide. We should not forget this.

The second letter was from Dr Keith Charlton about NICE's position on COPD.

I have long thought that most of the advice from NICE was either unhelpful or simply restates what has been known by many, if not most, GPs for years.

Pronouncements from allegedly eminent sources should always be considered critically. The record of many quangos and the Department of Health over the past few years has not been impressive. 'Authorities' are too ready to produce solutions to problems that don't actually exist or if they do might not matter.

These breaths of common-sense are both timely and welcome as GPs and the NHS embark on an experiment in uncertainty unrivalled since 1949.